Everything You Need To Know About Eating Disorders

People of every body size, gender, or age can struggle with their relationship with food

June 5, 2023

Conditions such as anorexia, bulimia, and binge eating disorder keep people from maintaining a healthy weight or from having a healthy relationship with food. While often assumed to be just a phase, eating disorders can have deadly outcomes if not properly addressed.

It is important to note that eating disorders are not a lifestyle choice. Those who have these conditions are not making a conscious decision to treat their bodies poorly. They aren’t “over-dieting” or “being uptight.” People with eating disorders are mentally and physically unwell and need medical and/or mental health assistance to move toward recovery.

Keep Reading To Learn

  • The truth about eating disorders
  • How to recognize symptoms of eating disorders in yourself or loved ones
  • How to successfully manage and treat eating disorders

What Is an Eating Disorder?

An eating disorder is a condition in which a person cannot maintain a balanced and healthy relationship with food. Depending on the condition, they may not eat enough, eat too much, or overly manage the calories they take in or put out.

People with eating disorders may also try to “control” their food, overexercise, develop rituals surrounding mealtimes, or refuse to eat with others. These are just a few examples of the ways eating disorders can manifest.

The overarching image of an eating disorder is an obsession with weight and appearance above health. People with anorexia, bulimia, binge eating disorder, and other eating disorders come to see themselves as physically unappealing in ways that do not reflect reality.

Types of Eating Disorders

There are four main types of eating disorders.

Anorexia Nervosa

Perhaps the best-known eating disorder, anorexia is a condition involving extreme weight loss. Due to distorted body image, people struggling with anorexia eat far less than they should to remain in good health. They are generally underweight by all metrics: age, stature, body type, and height.

People with anorexia primarily lose weight through extreme calorie restriction. They skip meals, eat far too little, and move food around on their plate rather than consuming it. Some people with anorexia may also purge after meals.

Anorexia is not exclusively related to people with thin bodies. While anorexia typically manifests as extreme weight loss, some people with larger bodies also struggle from it. Just because some people have larger frames or body mass indices does not mean they do not restrict calories. They may still be malnourished, even if they do not look like it.

The best way to identify whether a person is struggling with anorexia is to look for common signs of the condition rather than assuming anything based on body weight.

Characteristics of people with anorexia nervosa include but are not limited to the following behavioral and physical symptoms.

Behavioral symptoms:

  • Making frequent comments about feeling fat, overweight, unattractively shaped, or ugly
  • Voicing common complaints of abdominal pain, gastric distress, feeling cold, poor sleep, or anxiety
  • Refusing to eat certain foods, exhibiting concerns about eating in public, or avoiding making plans with others that involve food

Physical symptoms:

  • Inability to maintain a healthy body weight
  • Feeling dizzy or faint
  • Developing dry skin, dry and brittle nails, and brittle or thinning hair
  • Growing fine hair, called lanugo, all over the body
  • Healing unusually slowly from wounds, or getting sick easily and not recovering quickly

It is important to note that these symptoms are only potentially present. You should not assume someone doesn’t have an eating disorder just because these symptoms are not present or visible. It is possible, or even likely, that the person may be hiding some behaviors.

Just as eating disorders are not always obvious to the eye, they are also missed by lab tests. Although our bodies are excellent at maintaining balance even without food, cardiac arrest and electrolyte imbalances can strike without warning in people with anorexia and can prove fatal.

It is worth noting that men are more likely to die from anorexia than women. This is mainly because it is often assumed that men don’t have eating disorders, so recognition is less common. This often means that the condition is fairly advanced by the time it is addressed.

Watch Now!

Dr. David J. Alperovitz provides an overview of eating disorders, shares tips for recognizing key warning signs, and answers questions about diagnosis and treatment

Bulimia Nervosa

People living with bulimia usually have the same goal as those with anorexia: weight loss. As with anorexia, this doesn’t necessarily mean they are overweight. They may just see themselves through a distorted lens. That’s why bulimia, like other eating disorders, is a psychological as well as physical condition.

In bulimia, people will binge huge amounts of food in a short period of time. Then, they will try to get rid of it any way they can. This pattern of binge-purge can become addictive for some individuals.

Common elimination habits include any combination of the following:

  • Purging
  • Using laxatives
  • Overexercising
  • Restricting calories

Many people with bulimia are of normal weight or overweight. Their body image is still distorted, but they are less likely to be chronically underweight, so it may be difficult to see a physical change in someone with bulimia.

Bulimia has serious health consequences. Constant binging and purging can lead to chemical and electrolyte imbalances in the body. These can affect the heart and other organs. Stomach acid also erodes tooth enamel and can damage nails and skin. As with anorexia, electrolyte imbalance and heart conditions can lead to sudden death.

As with anorexia, a person with bulimia may look normal. That’s why it’s so important to understand the characteristics of this disease more fully.

Behavioral symptoms include:

  • Exhibiting mood swings and emotional overreactions to what seem like small issues
  • Making comments or showing behaviors that indicate hard dieting and a desire for weight loss
  • Using food rituals, avoiding eating in public or with others, skipping meals
  • Stealing or hoarding food
  • Exhibiting out-of-control eating or secretive eating
  • Disappearing after eating, often but not always to the bathroom
  • Relying on laxatives
  • Relying on mouthwash, mints, and gum to freshen breath that is sour from stomach acid

Physical symptoms include:

  • Having stained or discolored teeth, cavities, and swelling in the jaw
  • Showing unnatural bloating
  • Having fine hair growing all over the body
  • Experiencing weakness, fatigue, fainting, problems regulating temperature, and poor sleep
  • Showing dry and brittle hair and nails
  • Experiencing menstrual issues, including loss of period or irregular period
  • Healing unusually slowly and exhibiting poor immune function

Because bulimia, just like anorexia, can be deadly, it is critical to take notice of and do something about these signs immediately. If you or someone you love needs help, please seek out a medical or mental health professional.

In Her Own Words

Deconstructing Stigma participant Rachel

Rachel is a participant in McLean’s Deconstructing Stigma campaign, and she struggles with bulimia.

Read more about Rachel’s mental health story and her message of hope for those who are also struggling.

Rachel’s Story
Deconstructing Stigma participant Rachel

Binge Eating Disorder

Binge eating disorder, also called BED, is a condition in which someone eats large amounts of food at one time. They may continue to eat after they are full and even when they feel sick or “bursting.” Their eating habits often cause them to feel embarrassed, so they avoid gatherings that involve food. They may also withdraw so others are less likely to notice their behavior.

Although bulimia also has a binge-eating element, people with BED do not attempt to undo the binge. They do not overexercise, purge, or use laxatives. They also do not usually restrict their calories, although they may sometimes show interest in diets. People with BED may be underweight, despite their condition. They may also be normal weight or overweight.

Binge eating disorder is associated with many of the same dangerous health conditions as obesity, including but not limited to:

  • High blood pressure, high cholesterol, or coronary heart disease
  • Type 2 diabetes
  • Stroke
  • Sleep apnea
  • Gallbladder disease
  • Mental illness, including depression and anxiety

BED has serious health consequences, which may take longer to manifest than those of anorexia and bulimia but are no less fatal. Again, it’s very important to recognize the signs.

Behavioral symptoms can include:

  • Showing discomfort with eating around other people
  • Rescheduling or refusing to make plans that include eating with groups or even family members
  • Feeling worthless or disgusting
  • Having low self-esteem most or all the time
  • Scheduling life around binge-eating sessions
  • Engaging in short-lived fads or crash diets, but rarely sticking with food-restrictive behavior
  • Stealing food, hoarding food, or consuming large amounts of food at one time, often in secret

Physical symptoms include:

  • Experiencing weight fluctuations, which are sometimes extreme
  • Abdominal cramping, constipation, acid reflux, and other gastrointestinal complaints
  • Difficulty concentrating

Like all eating disorders, there’s no guarantee all or even any of these symptoms will be visible to other people. The person with BED may be so good at hiding signs of the condition that even people closest to them may feel confused as to what’s going on.

Remember that even though binge eating disorder doesn’t carry the same danger of sudden death as anorexia and bulimia, it can lead to lifelong mental distress and poor health.

BED is more than three times as common as bulimia or anorexia. The psychological component makes those with BED unable to stop eating even though it doesn’t feel good. People with BED dislike their behavior and wish they could stop, but they cannot.

Avoidant Restrictive Food Intake Disorder

Unlike the three disorders already mentioned, avoidant restrictive food intake disorder, or ARFID, is not about body image. People with ARFID do not feel as though they are fat or unappealing.

The condition is very similar to anorexia in that people who have this disorder eat less than they should. In children, this limits normal growth. In adults, it reduces nutrient intake. Over time, ARFID can lead to the same sudden, fatal outcomes as anorexia and bulimia.

The main reason people with ARFID avoid eating is because the experience itself is unpleasant to them. This may be because they do not like the texture of certain foods, or because they’re afraid they will choke or vomit.

When they do eat, they often eat much more slowly than a typical speed. This hampers not only nutrition, but social development, as eating with others is often difficult or impossible.

People with ARFID are more likely to be male and are usually younger. The main characteristics of the condition include:

  • Avoiding or not eating enough food
  • Reporting not being hungry
  • Complaining of abdominal pain

Children who exhibit symptoms of ARFID are very likely to live with other mental illnesses or developmental delays. Mood disorders affect one third of the children with ARFID, according to one study. This study also reported that three quarters of kids with ARFID also had anxiety, and one-fifth also reported having autism spectrum disorder.

Young man in hoodie looking directly at camera.

Recognizing Eating Disorders in Yourself and Others

Because there are so many different symptoms associated with eating disorders, it is helpful to have a working knowledge of worrying signs and symptoms.

Behavioral symptoms include:

  • Making frequent comments that convey a negative body image, such as “I’m fat”
  • Thinking inflexibly about food and not being spontaneous
  • Refusing to eat in front of others, avoiding mealtimes, or eating limited amounts
  • Maintaining an obsessive exercise regimen, regardless of events, weather conditions, etc.
  • Spending a lot of time looking in the mirror
  • Cooking for others but not eating the food themselves
  • Having a ritualistic approach to food that doesn’t seem healthy or normal
  • Exhibiting low self-esteem about being “fat” that doesn’t correlate to actual body weight or appearance

Physical symptoms include:

  • Looking malnourished, pale, too thin, or otherwise unhealthy
  • Experiencing disturbed sleep
  • Having trouble regulating body temperature
  • Having dry skin, brittle nails and/or hair, thinning hair, growth of fine hair on the body
  • Experiencing decreased appetite, abdominal pain, GI distress, and other gastrointestinal symptoms

Any of these signs warrant consulting with a health care provider. If you are concerned about someone who may have an eating disorder, it’s important to ask if they are struggling with their eating habits. If they are reluctant to talk about it, you should turn to a specialist for help.

If you are struggling, please take your health seriously. You may feel very vulnerable reaching out for help with any of these conditions, but in the end, it may save your life.

What Causes Eating Disorders?

Eating disorders are like any other mental health condition in that they have many causes. Any person will have their own individual reasons for developing an eating disorder. Most likely, these individuals don’t grasp what the specific reasons for their illness may be, which is where mental health treatment comes in.

At its foundation, people develop eating disorders because the feeling of control over food makes them feel less out of control in other areas of their lives.

Genetics and Family History

While genetics do not guarantee anything, eating disorders seem to run in families. A person whose parents or siblings have experienced an eating disorder is more likely to have one themselves.

Some studies indicate that serotonin levels in the brain may influence eating behavior, and imbalances may arise from genetic causes.

It can be hard to separate the two factors because your family can strongly influence your approach to food. It is not uncommon for family pressures to look thin or eat a certain way to cause eating disorders.

Media and the Environment

The average person lives their life awash in images of the perfect (or ideal) looking body. Most people are inundated with concepts of attractiveness that focus on being thin, trim, or fit.

Teens and children often lack the tools to cope with the feelings these images cause.

According to the Dove Girls and Beauty Confidence: The Global Report, more than half of girls around the world lack high body self-esteem. Eighty percent avoid activities they would otherwise engage in, while 70% risk their health to stay slim or report being less assertive when they don’t look how they want to.

Emotional Health

Because self-esteem is a critical element in healthy perception of one’s body, low emotional health can make an eating disorder more likely. Anxiety, depression, fights with loved ones, and difficult relationships can all cause a person to turn to unhealthy eating.

Physical and sexual abuse may also contribute to the development of a food-related problem. While control over food may temporarily soften some difficult feelings, it only leads to harder problems later.

Peer Pressure

Fearing what others think is a powerful motivator for people of any age. In young people, however, it is especially influential.

Peer pressure around body image can come in two general forms: bullying and friendly pressure.

In the former, children and youth are made to feel as though they are “less-than,” usually because of their weight or size. In the latter, friends may encourage a person to eat less, to control their eating in certain situations, or to look a certain way.

Life Changes

Life changes—even positive ones—are hard on everyone. They cause stress and anxiety, but at the same time, they often make people want to look their best. Some examples include starting a new school, going to college, getting a new job, or getting a divorce.

Even dieting too quickly can lead someone to slide into an eating disorder. Again, this doesn’t mean the person simply took dieting “too far” and can walk it back. It means that a significant mental change has taken place and the person no longer has control over their thoughts and approach to food.

Some jobs lend themselves to eating disorders. Disordered eating is especially common among athletes, models, and others whose success rests on their appearance.

What Is Body Dysmorphic Disorder?

Listen to Dr. Roberto Olivardia talk about body image and BDD on this episode of McLean’s podcast, Mindful Things.

Listen Now

Who Is at Risk of Developing Eating Disorders?

The long and short of it is that everyone is at risk of developing an eating disorder. Eating disorders affect individuals of any age, regardless of gender.

There are a number of groups known to commonly develop eating disorders.

People Who Are Bullied

Teasing from friends and family members is a predictor of binge eating, calorie restriction, and other unhealthy approaches to nutrition.

Athletes

Those who are expected to look and perform a certain way often enhance their training with unhealthy weight control measures, forms of eating, laxatives, and so on.

People With Type 1 Diabetes

Because people with Type 1 diabetes control their insulin levels, they can intentionally give themselves less than necessary. This leads to hyperglycemia and “calorie purging.”

Dieters and “Clean Eaters”

The recent trend toward eating “clean” can easily lead to calorie restriction.

Restricting your diet can lead to eating disorders and negatively affect your physical abilities, mood, concentration, and daily activities. Dieting often leads to constantly thinking about food, feeling deprived, and struggling to control eating habits.

Members of the LGBTQ+ Community

LGBTQ+ people have eating disorders at higher rates than others. Being other than heterosexual or cisgender predicts higher levels of laxative abuse, purging, and fasting.

Marginalized Community Members

Minorities and other marginalized people have a higher tendency toward eating disorders and are also less likely to receive help for their issues.

Low-Income Individuals

People who live near the poverty line are more likely to develop eating disorders than those with more wealth.

According to one study, teenage girls from low-income families have a 53% higher chance of developing bulimia than their wealthy counterparts.

People With Trauma or PTSD

Anyone who has significant trauma in their past, with or without post-traumatic stress disorder (PTSD), has a higher chance of developing an eating disorder.

People Who Struggle With Substance Addiction

People who use drugs and alcohol are significantly likelier to develop a food-related disorder.

According to Johns Hopkins Medicine, 30 million Americans have an eating disorder

How Are Eating Disorders Treated?

As with any illness, each person living with an eating disorder requires a unique treatment plan. Depending on need, patients may get care at a hospital, residential treatment center, or an outpatient or intensive outpatient setting.

A residential treatment center offers patients around-the-clock care for those who need their behavior and meals to be supervised. Residential treatment varies in length, depending on the level of care needed.

Some treatment programs allow patients to rest at home during the evenings but attend treatment during the day for several hours at a time, with most meals occurring at the treatment center.

Hospitalization may be required for patients that require medical monitoring or who need additional care in the form of intravenous fluids, tube feeds, or consistent vital signs checks.

Young girl staring at scale and measuring tape.

In outpatient care settings, the patient lives at home but attends weekly meetings with health care providers. This could include mental health providers, dietitians/nutritionists, or both. In intensive outpatient treatment, the patient attends several hours of treatment programming, often two to three days a week.

There is no one-size-fits-all approach to care, and because of this, patients will have individually tailored care to ensure the best possible outcome from their treatment.

Each person seeking treatment has a unique situation and may also have co-occurring mental health conditions, so it is important to consult the care team to determine the best path forward.

Treatment in all settings can take a wide variety of forms, including some of the following:

  • Cognitive behavior therapy
  • Acceptance and commitment therapy (ACT)
  • Dialectical behavior therapy (DBT)
  • Family-based treatment

Treatment to overcome an eating disorder is a collective effort on the part of the patient, their support network (parents, spouse, children, friends, etc.) and the care team.

Usually, the patient works with a primary care provider or other physician for an assessment. They also see a therapist, psychologist, or psychiatrist. In some cases, the team may also include a dietitian.

The methods by which the care team treats the problem vary depending on the patient. They address any life-threatening issues first and then move towards addressing symptoms.

For example, if the patient is not eating, that’s the primary concern. From there, the team works to change disordered thinking and behavior. They then work to create a new eating routine. Follow-up may last years to reinforce healing.

In some cases, the physician or psychiatrist may recommend antidepressants, anti-anxiety medication, or other medications to reduce symptoms and help the patient focus on recovery. While there are very few FDA-approved medications specifically designed for eating disorders, addressing other mental health issues, such as anxiety or depression, can lead to measurable improvement.

Men, Boys & Eating Disorders

Men hanging out together at outside table

It’s an often-believed myth that eating disorders don’t affect men and boys. Learn more about the silent battle of men, body image, and mental health.

Watch Now
Men hanging out together at outside table

Statistics About Eating Disorders

According to the National Association of Anorexia Nervosa and Associated Disorders, anorexia affects 0.3 to 0.4% of young women at any given time. The rate among men is quite high as well, with 0.1% exhibiting it.

Long-term studies show that girls between the ages of 12 and 20, tracked over 8 years, exhibit anorexia at a rate of 5.2%.

People between 15 and 24 with anorexia have a ten times greater chance of dying compared to peers who do not have the condition.

The estimated mortality rate for anorexia nervosa is about 10%. One in five anorexia deaths is by suicide, according to the National Eating Disorders Association (NEDA).

Bulimia affects young people at similar rates to anorexia. At any given time, among young people, 0.1% of men and 1% of women exhibit bulimia. The previously mentioned long-term study of girls between 12 and 20 found a 5.2% incidence of bulimia. Other studies show that 1.5% of women and 0.5% of men will experience bulimia in their lifetime.

Studies show that 3.5% of women and between 0.9 and 2% of men will develop binge eating disorder in their lifetimes.

LGBTQ+ adults and adolescents experience higher rates of eating disorders and disordered eating patterns than their heterosexual and cisgender counterparts.

Gay males are believed to represent 5% of the total male population, but 42% of males who have eating disorders identify as gay.

Gay males are more likely to report disordered eating behaviors—seven times more likely to report binging, and 12 times more likely to report purging—than heterosexual men.

Heightened rates of binging and purging were found in people who identified as gay, lesbian, bisexual, or “mostly heterosexual” when compared to their heterosexual peers.

Black and Latinx members of the LGBTQ+ community have similar prevalence rates of eating disorders when compared to those that identify as white.

Dispelling Myths About Eating Disorders

Below are some of the most common myths about eating disorders that can contribute to stigma, misunderstanding, and even keep people from seeking treatment.

Myth: Families Cause Eating Disorders

Family history and genetics can contribute to eating disorders, but they are not necessarily the cause. This is something a patient will usually speak about with their care team, if applicable.

Myth: Eating Disorders Are a Choice

Like other mental illnesses, eating disorders arise as the mind’s way of coping with other issues. To treat eating disorders, the patient must address those other factors. This may take time and almost always involves a therapist.

Myth: Careful or Picky Eating Habits Are an Eating Disorder

“Eating disorders are the same as careful eating, so everyone has an eating disorder of some kind.”

This is not the case.

Eating disorders are not simply a more extreme form of eating cleanly, mindfully, or carefully. They are a form of mental illness characterized by a false perception of reality—even in the case of ARFID, where the patient may perceive food to be dangerous, which is almost never true.

While many people are fixated on or distressed about weight, this doesn’t mean they exhibit disordered eating.

Myth: Eating Disorders Are Impossible To Recover From

They can sometimes be difficult to treat, but recovery is definitely possible. A patient dedicated to developing a healthy relationship with food can work to help resolve the issues that caused the disorder.

The time frame for recovery depends on the individual.

Some people can address their disorder in earlier stages of the illness. In that case, getting treatment before the disorder has progressed limits its mental and physical impact on the patient.

In other cases, the disease progresses much more. In these instances, recovery may be more challenging but is still achievable.

Myth: Only Girls Get Eating Disorders

Many boys and men also experience them. In fact, men are more likely to die from an eating disorder since the condition often goes unrecognized for far longer.

Myth: Only Teens and Young Adults Have an Eating Disorder

Anyone can develop an eating disorder at any time, though they are more frequently found in younger people. This is due to a mixture of peer pressure and emotional development. With support, however, even the young people most strongly affected can move past the issue.

How Eating Disorders Are Diagnosed

Health care professionals use many of the same warning signs discussed in the individual eating disorder information above to screen for possible eating disorders. They mainly look for:

  • Obsession with weight loss and appearance or unhealthy patterns of eating
  • Avoidance of specific food groups or settings, like restaurants or the school cafeteria
  • Emotional warning signs, such as being withdrawn or irritable
  • Physical problems with temperature regulation, sleep, GI issues, teeth, hair, nails, vital signs, fainting, muscle weakness, dizziness, or difficulty concentrating
  • Abnormal lab results, including white blood cell counts, hormone levels, nutrient deficiencies, or anemia

If an eating disorder has advanced, the health issues become accordingly more severe. These may include heart problems, severe stomach pain or rupture, blocked intestines, bacterial infections, nausea and vomiting, blood sugar irregularities, undigested food in the GI tract, sleep apnea, kidney failure, and more.

When and How To Reach Out for Help

If you think you or a loved one may have an eating disorder, reach out to them, a health care professional, and/or a trusted outside resource. The best thing you can do if you’re concerned about yourself or your loved one is to get help immediately.

Below are some of the best numbers to call:

Eating disorders are nothing to be ashamed of. However, they can be life-threatening if unaddressed.

With treatment, you or a loved one can be on the way to a physically—and mentally—healthier life.

McLean Is Here to Help

Staff talk with patient

If you or a loved one are struggling with an eating disorder, McLean offers world-class mental health care. Call us today at 617.855.3410 to learn more about treatment options.

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Staff talk with patient

Want More Info?

Looking for even more information about eating disorders? You may find these resources helpful.

Interesting Articles and More

Learn more about eating disorders and what you can do if you or a loved one is displaying signs they are struggling.

Helpful Organizations

These organizations may also have useful information:

Academy of Eating Disorders
The Academy of Eating Disorders is an organization that aims to advance eating disorder prevention, education, treatment, and research. The AED advocates for best practices in clinical care, supports cutting-edge research in the field, and fosters collaboration with leaders in the field from around the world.

Alliance for Eating Disorders Awareness
A nonprofit organization dedicated to providing programs and activities aimed at outreach, education, and early intervention for all eating disorders. Their goal is to raise awareness, eliminate stigma, promote access to care and support for those susceptible to, currently struggling with, and recovered from eating disorders.

Eating Disorders Anonymous
A fellowship of individuals who share their experience, strength, and hope with each other that they may solve their common problems and help others to recover from their eating disorders.

Multi-Service Eating Disorders Association
MEDA works to combat the spread of eating disorders through educational awareness and early detection. MEDA serves as a support network and resource for patients, clinicians, educators, and the general public.

National Association of Anorexia Nervosa and Associated Disorders
ANAD is a nonprofit organization that works in the areas of support, awareness, advocacy, referral, education, and prevention of eating disorders.

National Eating Disorders Association
NEDA is the largest nonprofit organization dedicated to supporting individuals and families affected by eating disorders. They serve as a catalyst for prevention, cures, and access to quality care.

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